Male Gynaecomastia

Male Gynaecomastia is a common disorder seen by many plastic surgeons. This  and can be the result of hormonal changes, heredity, obesity or the use of certain drugs.

The most common causes of gynaecomastia in adult men that seek medical assessment include:

• Pubertal gynecomastia that does not resolve – 25 per cent
• Drugs – 10 to 25 per cent
• Unknown causes – 25 per cent

Gynaecomastia often causes emotional discomfort and impairs self-confidence. Some men may even avoid certain physical activities and intimacy to hide their condition. It is characterized by the presence of unilateral (one breast) or bilateral (both breasts) excess localised fat, glandular tissue development and excess breast skin.

In severe cases, the weight of excess breast tissue may cause the breasts to sag and stretch the areola (the dark skin surrounding the nipple). In these cases, the position and size of the areola can be surgically improved, and excess skin may be reduced. Surgery reduces breast size in men, flattening and enhancing the chest contours.

For this surgery, men must be healthy, of normal weight and have realistic expectations. They must be bothered by the feeling that their breasts are too large and whose condition cannot be corrected through alternative medical treatments. Teenagers may benefit from surgery, although secondary procedures may be needed in the future should breast development continue.

The decision to have plastic surgery is extremely personal, and patients need to decide if the benefits will achieve their goals. They also need to know if the risks and potential complications of gynaecomastia surgery are acceptable.

Gynaecomastia surgery risks include:

• Anaesthesia risks
• Bleeding (hematoma)
• Infection
• Fluid accumulation (seroma)
• Deep vein thrombosis, cardiac and pulmonary complications
• Breast asymmetry,
• Breast contour and shape irregularities
• Changes in nipple or breast sensation which may be temporary or permanent
• Fatty tissue found in the breast might die (fat necrosis)
• Persistent pain
• Poor wound healing or unfavourable scarring
• Possibility of revision surgery

In cases where male gynaecomastia is mainly the result of excess fatty tissue, liposuction techniques alone can be used to remove this extra fat.

At Precision Aesthetics, in the majority of cases, Laser liposuction is combined with SAFE Liposuction to remove excess fatty tissue and at the same time tighten skin.

This then obviates the need to excise excess skin. Sometimes gynaecomastia is treated by both liposuction and excision. If there is any sub-aereolar breast tissue present, this can be excised via an inferior hemi-periaereolar incision which leaves an excellent scar camouflaged at the skin aereolar interface.

More extensive excision techniques are recommended when glandular breast tissue or excess skin must be removed to correct gynecomastia. Excision is also necessary if the areola needs to be decreased in size or if the nipple needs to be repositioned to a more natural male contour. Incision patterns vary depending on the extent of tissue needs to be excised.

During the gynaecomastia surgery recovery period, an elastic support garment will be used to decrease swelling and support the new chest contour as it heals after surgery.

A small, thin tube may be temporarily placed under the skin to drain any excess blood or fluid that may collect. Patients are discharged on medication following the surgery and told to return the following week for assessment and a dressing change. Regular activities are resumed at 6- 8 weeks, but gentle exercise can start at 2-3 weeks depending on if liposuction alone was used or if surgery was required.

The final results of gynaecomastia surgery are permanent in many cases. However, if gynaecomastia resulted from the use of certain prescription medications, drugs (including steroids) or weight gain, you must be entirely free from these substances and remain at a stable weight to maintain your results.

Gynaecomastia surgery results are immediately visible. Over time, post-surgical swelling will resolve, and incision lines will fade. Satisfaction with your new image should continue to grow as you recover from surgery.

The final results of your gynaecomastia surgery may take 3-6 months to achieve. Incision lines are permanent but will continue to fade over time.

Any surgical treatment to correct male gynaecomastia will require incisions. While most incision lines are concealed within natural contours, some may be visible and are a necessary result of male breast reduction surgery.

All gynaecomastia surgery scars are permanent, even though some scars may be concealed in the natural contours of the breast. Your improved upper body will likely enhance your self-image and confidence, whether in a shirt and tie, a t-shirt, or baring your chest at the beach.

The practices of surgery is not an exact science. Although good results are expected from your procedure, there is no guarantee. In some situations, it may not be possible to achieve optimal results with a single surgical procedure to treat gynaecomastia.

Another surgery may be necessary to perform additional tightening or repositioning of the breasts or to treat any complications that may occur.